Role Of Team Research Articles

The effect of an online micro CE/CME on the multidisciplinary care of patients with nonmelanoma skin cancer.

e21006 Background: Nonmelanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC), are the most common malignancies diagnosed in the US and worldwide. While most are successfully cured with local therapies or surgery alone, immunotherapy agents have been added to the arsenal for advanced tumors that are unresectable or unlikely to be cured with surgery alone. Thus, the multidisciplinary care model in this clinical setting has numerous advantages; however, many healthcare professionals (HCPs) may not fully recognize the role of their colleagues and their value in caring for affected patients. The objective of this study was to assess the educational impact of an online micro continuing [medical] education (CE/CME) activity on the knowledge and competence of HCPs’ with respect to the role and value of the multidisciplinary team in the optimal care of patients receiving immunotherapy for NMSC. Methods: The educational activity consisted of a collection of six online video-based micro-CE/CME-certified chapters, presented by six respected NMSC experts, allowing learners to choose their chapters for participation. Educational impact was assessed with repeated paired pre-/post-assessment study design, where individual participants served as their own control. A McNemar’s test assessed significant levels of changes reported with P values <.05 considered statistically significant. The activity launched September 2023; data were collected until January 2024. Results: The educational activity resulted in overall statistically significant improvements in HCPs’ knowledge and competence after education by chapter and by HCP audience type ( P < .01), including oncologists, dermatologists, surgeons, nurses, and pharmacists. Results presented below highlight the improvements in HCPs’ knowledge and competence by chapter. Conclusions: This analysis demonstrates the success of an online CE/CME activity with micro video chapters on improving HCPs’ knowledge and competence related to the value of the multidisciplinary team members in the comprehensive care of patients receiving immunotherapy for the treatment of NMSCs. Despite these significant improvements, additional educational activities are needed to address residual gaps and further increase HCPs’ ability and comfort in providing care in this clinical setting. [Table: see text]

Neurocritical Care for Patients With Ischemic Stroke.

Management of stroke due to large vessel occlusion (LVO) has undergone unprecedented change in the past decade. Effective treatment with thrombectomy has galvanized the field and led to advancements in all aspects of care. This article provides a comprehensive examination of neurologic intensive care unit (ICU) management of patients with stroke due to LVO. The role of the neurocritical care team in stroke systems of care and the importance of prompt diagnosis, initiation of treatment, and continued monitoring of patients with stroke due to LVO is highlighted. The management of complications commonly associated with stroke due to LVO, including malignant cerebral edema and respiratory failure, are addressed, stressing the importance of early identification and aggressive treatment in mitigating negative effects on patients' prognoses. In the realm of medical management, this article discusses various medical therapies, including antithrombotic therapy, blood pressure management, and glucose control, outlining evidence-based strategies for optimizing patient outcomes. It further emphasizes the importance of a multidisciplinary approach to provide a comprehensive care model. Lastly, the critical aspect of family communication and prognostication in the neurologic ICU is addressed. This article emphasizes the multidimensional aspects of neurocritical care in treating patients with stroke due to LVO.

Nurture clinic: Promoting mental health of children and adolescents.

Nurses play an important role in multidisciplinary teams while treating children and adolescents with mental health issues. Nurses should recognize and capitalize on the client's and family's strengths as they develop interventions, provide education, and refer to resources as appropriate. It is a mixed-method research, with an initial qualitative phase of obtaining data by in-depth interviews of parents on caring for children and adolescents with mental illness followed by quantitative assessment of the level of care dependency and implementation of need-based nursing interventions to the children and adolescents with mental illness. A total of 235 boys and 123 girls received the interventions. The majority of them (51.4%) were boys aged between 6 and 12 years and the highest diagnosis was attention deficit and hyperactivity disorder (ADHD) (34%). The need-based interventions required were nutrition (90%), prevention of injury and infection (83%), and positive and productive engagement (80%). Other interventions included self-care, physical activity, and medication. Need-based nursing interventions help in promoting the mental health of children and adolescents. This approach may be extended to primary care facilities and community mental healthcare by nurses.

Simulation Training for Emergency Sternotomy in the Cardiovascular Intensive Care Unit.

Emergency resternotomy in the intensive care unit for a patient who has undergone cardiac surgery can be daunting for surgeons and critical care staff. Clinicians involved are often unfamiliar with the surgical instruments and techniques needed. After an emergency intensive care unit resternotomy resulted in suboptimal performance and outcome, protocols for emergency resternotomy were established and improved. Education and simulation training were used to improve staff comfort and familiarity with the needed techniques and supplies. The training intervention included simulations to provide hands-on experience, improve staff familiarity with resternotomy trays, and streamline emergency sternotomy protocols. Preintervention and postintervention surveys were used to assess participants' familiarity with the implemented plans and algorithms. All 44 participants (100%) completed the preintervention survey, and 41 of 44 participants (93%) returned the postintervention survey. After the intervention, 95% of respondents agreed that they were prepared to be members of the team for an emergency intensive care unit sternotomy, compared with 52% of respondents before the intervention. After the intervention, 95% of respondents strongly agreed or agreed that they could identify patients who might need emergency sternotomy, compared with 50% before the intervention. The results also showed improvement in staff members' understanding of team roles, activation and use of the emergency sternotomy protocol, and differences between guidelines for resuscitating patients who experience cardiac arrest after cardiac surgery and the post-cardiac arrest Advanced Cardiovascular Life Support protocol. Results of this quality improvement project suggest that simulation training improves staff comfort with and understanding of emergency resternotomy.

Does feedback type matter? The superiority of process feedback over performance feedback in interdependent teamwork

BackgroundFeedback plays an important role for individuals and teams. While there is a lot of research on performance feedback, positive effects of process feedback (divided into individual- and team-level) are little studied. In particular, the simultaneous consideration of individual variables and feedback characteristics and their influence on feedback perceptions in the feedback process is missing. AimsThe present study analyzes the effects of three feedback conditions (i.e., performance feedback, team-level process feedback, and individual-level process feedback) on feedback perceptions (i.e., usefulness and fairness), as well as on feedback acceptance and team awareness. Sample142 randomly assigned two-person teams. MethodsEach team worked on four computer-based team tasks in the C³Fire microworld and received one type of feedback after completing each 15-min scenario. Measurements were taken after the second (T1) and fourth (T2) scenarios. ResultsStructural equation modeling results revealed positive effects of feedback orientation at T0 on feedback usefulness and feedback fairness at T1, and of usefulness and fairness on feedback acceptance at T2. Feedback usefulness (but not fairness) was also a positive predictor of team awareness at T2. Team-level process feedback resulted in overall positive effects on usefulness and fairness. In general, the effects on perceived usefulness appeared to be stronger than on perceived fairness of the feedback. ConclusionsTeam-level process feedback in teamwork and individual feedback orientation are important for perceived usefulness and fairness of the feedback. Team awareness may be enhanced by increasing feedback usefulness; feedback acceptance may be enhanced by increasing feedback usefulness and fairness.

Holistic approach to care for patients with endometriosis.

Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis. Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration. Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.

Exploring the Impact of Digital Transformation on Manufacturing Environment, Social Responsibility, and Corporate Governance Performance: The Moderating Role of Top Management Teams

In the digital economy era, digital transformation is crucial for competitiveness in traditional industries, particularly in manufacturing. This study aimed to examine how digital transformation impacts the manufacturing environment, social responsibility, and corporate governance (ESG), with a focus on the role of senior executive teams. Using empirical analysis of Chinese A-share listed companies from 2010 to 2019, this study found that digital transformation promotes ESG performance in the manufacturing industry. The findings revealed that the educational level, CEO tenure, and professional background diversity of senior management teams moderate this relationship, enhancing ESG performance. This study enriches and expands the existing knowledge system on this topic by integrating theories related to the digital economy and resource-based theories. It provides methodological guidance for the manufacturing industry to improve its environmental, social, and governance performance and achieve rapid development. Additionally, it offers practical suggestions for the government, manufacturing enterprises, and senior executive teams on how to better play their performance in digital transformation and ESG governance. This will assist the manufacturing industry enhance its level of digital transformation and continuously improve its ESG management and governance.

A Qualitative Study on Nurses' Experiences Working in Burn Units in South Punjab, Pakistan.

Background: Nurses play an integral role in the multidisciplinary team managing care for burn patients. Their unique insights and experiences in such high-stress environments are crucial yet often underexplored. This study aims to illuminate the challenges and experiences of nurses in burn units within tertiary care hospitals in South Punjab, Pakistan. Objective: To explore and document the experiences of nurses working in burn units, focusing on the challenges they face and the coping mechanisms they employ. Methods: A qualitative study was conducted in 2022 using purposeful sampling to select 16 nurses from burn units at tertiary care hospitals in South Punjab, Pakistan. Data were collected through semi-structured, in-depth interviews and analyzed using thematic analysis to identify key themes and sub-themes. Results: Analysis of the interview data revealed four main themes and sixteen sub-themes. The main themes identified were Workload, Spiritual Beliefs in Patient Care, Nursing Education Services in Hospitals, and Work-Life Balance. These themes encompass the physical, emotional, and spiritual challenges faced by nurses, as well as their educational needs and the impact of their work on personal life. Conclusion: Nurses in burn units encounter numerous challenges that affect both their professional duties and personal lives. There is a critical need for better support structures, including modern facilities, continuous training, and more attentive administrative practices. Enhancements such as increased staffing, unit rotation, and provisions for financial and motivational incentives are necessary to improve care for burn patients and support the well-being of nurses.

The Role of Internal Audit In Financial Risk Management

This study delves into the role of internal audit teams in managing financial risks within companies, focusing on their contribution to organizational resilience. Through careful analysis, the research explores how these teams identify and address financial risks, offering insights into how they safeguard a company's assets and interests. The findings underscore the critical role internal audit practices play in recognizing and mitigating financial risks, providing clear assessments and recommendations to bolster organizational resilience.

Transforming congenital heart disease management: Advances in fetal cardiac interventions.

This review addresses the transformative advancements in fetal cardiac interventions (FCI) for congenital heart diseases (CHD), with a particular focus on aortic stenosis with evolving hypoplastic left heart syndrome, pulmonary atresia with an intact ventricular septum, and HLHS with an intact atrial septum (HLHS-IAS). We outline the specific FCI techniques employed, the refined criteria for selecting appropriate fetal and maternal candidates, and the promising yet varied outcomes associated with these procedures. Procedural strategies and clinical decision-making are examined as we take into account the fetal pathophysiology and the benefits and risks of early intervention. We highlight the role of multidisciplinary teams in improving technical success and managing immediate procedural complications, which have led to significant improvements in procedural outcomes. Additionally, the review discusses the long-term outcomes, challenges, and future research directions in FCI, emphasizing the necessity for continuous innovation and collaboration across specialties to advance the management of CHD. The integration of new technologies and research findings holds the promise of further enhancing FCI success rates and patient outcomes.

Mathematics teachers' interaction patterns and role changes in online research-practice partnerships: A social network analysis

Research–Practice Partnerships (RPPs), in which researchers and teachers come together with the shared aim of driving educational improvement, have lately gained recognition in the education community. Whilst studies have demonstrated the positive effects of RPPs, potential challenges in establishing long-term and mutually beneficial RPPs have been reported. To understand these challenges, the present study explores dynamic changes in team interaction patterns and roles using Social Network Analysis (SNA), then employs qualitative analysis to elaborate the mechanisms underlying these changes and resulting outcomes. The visual and quantitative results of the SNA reveal that interaction patterns shifted from a researcher-centered (hierarchical) pattern to a decentralized pattern, with increasing numbers of participants exhibiting a higher level of activity and exchange over time across the four discussions in a RPP. As for role changes, researchers played more of a leading role in the first two discussions, while teachers played a more equal role in subsequent discussions. The qualitative findings identify some key factors that lead to the changes in interaction patterns and roles, including: the process of negotiating meaning through lesson study; the establishment of trust between participants; and a concern for how role changes may positively impact teachers' and researchers’ professional development. These findings thus offer insights into how to create more effective and long-lasting RPPs.

"You don't get side effects from social prescribing"-A qualitative study exploring community pharmacists' attitudes to social prescribing.

Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies. A qualitative phenomenological approach was used. A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed. The sample included largely male pharmacists (63.3%) with less than five years' experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team's role to optimise health outcomes. The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

Hybrid extracorporeal cannulation for aortic root pseudoaneurysm re-operation: The role of a multidisciplinary team.

Introduction: Adequate cerebral protection for aortic reoperation is challenging and optimal technique is still controversial.Case Report: We report a hybrid cannulation approach to achieve safe cerebral protection during circulatory arrest to repair an aortic root pseudoaneurysm.Conclusion: A multidisciplinary approach combining conventional techniques and interventional expertise could be considered in complex aortic scenario.

Linking sales force integration into NPD to salesperson retention: toward a systematic framework

Retaining talented salespeople is crucial for a company’s survival. One effective strategy for retaining employees is to actively involve them in significant business decisions. Salespeople, however, differ significantly from their colleagues, for example, they are typically highly customer-oriented. Therefore, integrating them into new product development (NPD) may be a potentially valuable approach for firms to retain them. Nonetheless, salesforce integration (SI) into NPD is more intricate than initially thought. It may involve both psychological SI benefits (such as feeling valued or competent) and costs (including potential conflicts with NPD team members or role conflicts), thus differently affecting a salesperson’s willingness to stay with the firm. To learn more about the intriguing link between SI into NPD and salesperson retention, we conducted a qualitative study and applied grounded theory to conceptualize this relationship. We identify key mediators (psychological SI benefits and costs) and moderators (such as company, NPD team, salesperson, procedural, relationship, or product characteristics) that can influence the SI-into-NPD-salesperson-retention connection and develop related, relevant propositions. All of these insights are integrated into a cohesive framework and we present a research agenda to guide future exploration of this critical subject. Furthermore, we derive and discuss implications for both academics and practitioners.

The association between population health management tools and clinician burnout in the United States VA primary care patient-centered medical home

BackgroundTechnological burden and medical complexity are significant drivers of clinician burnout. Electronic health record(EHR)-based population health management tools can be used to identify high-risk patient populations and implement prophylactic health practices. Their impact on clinician burnout, however, is not well understood. Our objective was to assess the relationship between ratings of EHR-based population health management tools and clinician burnout.MethodsWe conducted cross-sectional analyses of 2018 national Veterans Health Administration(VA) primary care personnel survey, administered as an online survey to all VA primary care personnel (n = 4257, response rate = 17.7%), using bivariate and multivariate logistic regressions. Our analytical sample included providers (medical doctors, nurse practitioners, physicians’ assistants) and nurses (registered nurses, licensed practical nurses). The outcomes included two items measuring high burnout. Primary predictors included importance ratings of 10 population health management tools (eg. VA risk prediction algorithm, recent hospitalizations and emergency department visits, etc.).ResultsHigh ratings of 9 tools were associated with lower odds of high burnout, independent of covariates including VA tenure, team role, gender, ethnicity, staffing, and training. For example, clinicians who rated the risk prediction algorithm as important were less likely to report high burnout levels than those who did not use or did not know about the tool (OR 0.73; CI 0.61-0.87), and they were less likely to report frequent burnout (once per week or more) (OR 0.71; CI 0.60-0.84).ConclusionsBurned-out clinicians may not consider the EHR-based tools important and may not be using them to perform care management. Tools that create additional technological burden may need adaptation to become more accessible, more intuitive, and less burdensome to use. Finding ways to improve the use of tools that streamline the work of population health management and/or result in less workload due to patients with poorly managed chronic conditions may alleviate burnout. More research is needed to understand the causal directional of the association between burnout and ratings of population health management tools.

The vital role of clinical pharmacy services within the hospital at home interdisciplinary team.

Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy's clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team. A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were drug administration change (37%), medication reconciliation (29%), and antimicrobial stewardship (15%). Each of the top 3 types were further evaluated by subtype. Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs.

Implementation Barriers and Recommendations for a Multisite Community Health Worker Intervention in Palliative Care for African American Oncology Patients: A Qualitative Study.

Background: Palliative care remains underutilized by African American patients with advanced cancer. Community health workers (CHWs) may help improve palliative care outcomes among this patient population. Objectives: To explore barriers to success of a proposed CHW intervention and synthesize design and implementation recommendations to both optimize our intervention and inform others working to alleviate palliative care disparities. Design: Semi-structured qualitative interviews. Setting/Subjects: Key informants were health care professionals across clinical, leadership, and community health fields. Participants were recruited through purposive sampling from Baltimore, Maryland; Birmingham, Alabama; and Salisbury, Maryland. Measurements: Interviewers used an interview guide grounded in established implementation science models. Data were analyzed through a combined abductive/deductive approach by independent coders. A framework methodology was used to facilitate thematic analysis. Results: In total, 25 professionals completed an interview. Key informants discussed multiple barriers, including at the patient level (lack of knowledge), clinician and facility level (decreased workflow efficiency), and health system level (limited funding). Recommendations related to the intervention's design included high quality preintervention CHW training and full integration of CHWs into the care team to "bridge" divides between outpatient, inpatient, and at-home settings. Intervention delivery recommendations included clearly defining care team roles and balancing flexibility and standardization in CHW support approaches. These recommendations were then used to adapt the planned intervention and its implementation process. Conclusions: Clinicians, cancer center leaders, and CHWs identified multilevel potential barriers to the intervention's success but also described recommendations that may mitigate these barriers. Key informant input represents an important step prior to initiating CHW-based interventions.

Sustainable quality improvement: An essential ingredient for sustainability in modern medical curricula?

Health care delivery contributes a significant carbon footprint in the United Kingdom, and paradoxically climate change is linked to poorer human health outcomes. New General Medical Council (GMC) requirements mandate medical graduates must be able to apply sustainable care to their practice. Implementation of sustainable health care (SHC) teaching is a new challenge for medical schools, and there are several identified barriers including an overcrowded curriculum, lack of expertise within faculties, lack of institutional support and inadequate assessment techniques. We established a new SHC curriculum spiralling throughout the overall medical curriculum, and as part of this introduced a sustainable quality improvement (susQI) project to our final year cohort. SusQI considers the environmental, social and financial impacts as well as patient and population outcomes. Our students undertook this in their final year GP assistantships. We sought multi-sourced data through focus groups, formal end of placement feedback, informal feedback and external feedback. We applied thematic analysis to focus group transcriptions and triangulated with the other data sources. We identified some common themes: First, susQI was enjoyed and valuable; second, it allowed meaningful participation; third, it created a co-learning environment; and fourth, timing and curriculum placement are important when integrating susQI. SusQI can implement SHC into the overcrowded medical curriculum in a low cost, low resource manner without the need for experienced faculty. SusQI is empowering for students and grants them an active team role. Expansion into secondary and tertiary care is feasible, and we contend that susQI can be placed in other health care curricula.

Critical care nurses' role in rapid response teams: A qualitative systematic review.

To analyse the qualitative evidence on the role of critical care nurses in rapid response teams. Qualitative systematic review. This qualitative systematic review employed Bettany-Saltikov and McSherry's guidelines and is reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. Two pairs of blinded researchers screened the articles. The data were synthesised using a thematic analysis approach. A systematic literature search was conducted using the CINAHL, Embase and MEDLINE databases. Seven studies were included, and three main roles were identified: (1) balancing between confidence and fear in clinical encounters, (2) facilitating collaboration and (3) managing challenging power dynamics in decision-making. Critical care nurses possess extensive knowledge and skills in providing critical care to patients experiencing deterioration on general wards. They play a vital role in facilitating collaboration between team members and ward staff. Furthermore, within the rapid response team, critical care nurses assume leadership responsibilities by overseeing the comprehensive coordination of patient care and actively engaging in the decision-making process concerning patient care. Highlighting the central role of critical care nurses in rapid response teams as well such a team's benefits in healthcare organisations can promote applications for funding to support further quality assurance of rapid response teams and thus enhance patient safety. Health care organisations can assure the quality of rapid response team by providing economical resources and training. The education providers should facilitate and standardise curriculum for critical care nursing students to achieve necessary knowledge and skills as members in rapid response teams. No patient or public contribution.

Collaborative defense in the Arctic: Strengthening Norway's oil sector resilience through knowledge sharing and vigilance against drone threats

AbstractNorway's oil sector faces significant security challenges due to rapid technological advancements and heightened geopolitical tensions, particularly concerning threats from Russian drones. The sector maintains a vigilant approach, continually monitoring and adapting to evolving threats. This study investigates strategies employed by sector companies to mitigate challenges, emphasizing collaboration, effective network utilization, and learning from past incidents to enhance operational resilience. Our analysis aligns with three thematic areas from the Generic Resilience Management Guidelines developed under the EU‐funded H2020 project DARWIN: enhancing coordination in emergency response operations, managing adaptive capacities, and updating procedures and checklists. The study underscores the role of task forces, interdisciplinary teams, and collaborative efforts among industry operators in enhancing adaptability to threats. Findings indicated that although a willingness to draw insights from past incidents exists, a predominant reactive approach to learning prevails. Furthermore, a culture of secrecy prevalent in the sector inhibits knowledge sharing, potentially challenging overall resilience. In this complex context, proactive and transparent security approaches are imperative for Norway's oil sector to enhance resilience. Organizations should adopt a dynamic, technology‐integrated risk management approach, involving continuous policy revision and stakeholder engagement, as suggested in contemporary resilience enhancement strategies.